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Marked changes in platelet count and function following pediatric congenital heart surgery
Jo Bønding Andreasen1, Anne-Mette Hvas, Hanne B Ravn
1Department of Anaesthesiology and Intensive Care, Aarhus University Hospital, Aarhus N, Denmark.
Insights
Congenital heart surgery using cardiopulmonary bypass (CPB) significantly reduces platelet count and function in children. Longer CPB duration and hypothermia are linked to these adverse effects on platelet activity.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Pediatric Critical Care
Background:
- Reduced hemostatic capacity is a known complication after congenital heart surgery with cardiopulmonary bypass (CPB).
- This hemostatic impairment stems from factors including dilutional coagulopathy and platelet activation within the CPB circuit.
- Understanding platelet behavior post-CPB is crucial for managing surgical outcomes in pediatric patients.
Purpose of the Study:
- To investigate alterations in platelet count and function in pediatric patients undergoing CPB.
- To identify potential correlations between CPB parameters and changes in platelet hemostatic capacity.
Main Methods:
- A prospective, observational study involving 40 children undergoing CPB.
- Platelet count and function were assessed using the Multiplate Analyzer(®) before surgery, immediately after bypass, and on postoperative day 1.
- Conventional coagulation tests and rotational thromboelastometry (ROTEM(®)) were also performed.
Main Results:
- A significant decrease in platelet count was observed immediately after CPB, persisting through postoperative day 1 (P < 0.001).
- Platelet function, measured by ADP and TRAP induction, was significantly reduced post-CPB (P < 0.001 and P = 0.03, respectively).
- CPB duration correlated with decreased platelet count (r = -0.62) and function (r = -0.42 to -0.63). Moderate to deep hypothermia during CPB was associated with reduced platelet function (P = 0.01–0.12).
Conclusions:
- Pediatric patients undergoing corrective heart surgery exhibit significantly reduced platelet count and function after CPB.
- The duration of CPB and the degree of hypothermia are key factors associated with impaired platelet function post-surgery.
Background:
Reduced hemostatic capacity is common following congenital heart surgery using cardiopulmonary bypass (CPB). The etiology is multifactorial with dilutional coagulopathy, as well as platelet adhesion and activation in the CPB circuit and oxygenator. The purpose of the present study was to evaluate platelet count and function in children following CPB.
Methods:
In a prospective, observational study comprising 40 children, platelet count and function (Multiplate Analyzer(®)) were measured before surgery, immediately after bypass, and on the first postoperative day. Furthermore, conventional coagulation analysis and thromboelastometry (ROTEM(®)) were carried out.
Results:
A significant decrease in platelet count was observed immediately after coming of bypass (P < 0.001) and persisted to the first postoperative day (P = 0.002). Platelet function was reduced immediately after bypass after induction with ADP (P < 0.001) or TRAP (P = 0.03). The duration of CPB correlated significantly with the decrease in platelet count (r = -0.62, P = 0.0001) and reduction in platelet function (r = -0.42-0.63; P < 0.01). Moderate to deep hypothermia during CPB was associated with a decreased platelet function (P = 0.01-0.12), whereas cyanosis or previous heart surgery caused no further changes in platelet function following CPB.
Conclusion:
Both platelet count and platelet function were significantly reduced after CPB in children undertaken correctional heart surgery. Duration of CPB and hypothermia was associated with significant changes in platelet function.
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